HomeMy WebLinkAbout0708 ~eclaration of Domicile and Citizenship • -
TO THE STATE AND COUNTY TAX ASSESSOR, r/~246
_ St. ZuCie ~OUNTY, FLORIDA: ~
!
This is my declaration of Domicile and Citizenship in the State of Ftorida that ! am Ciling this day in ?
;
accordance, and in conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident of Db~r Pttrk l~e~rr York and I '
(citr) (state)
resided at 285 We~t 12th street . However, i have changed my.domicile to
(Strat and Number)
and am and have been a bona tide resident of the State of Florida since 30th day of ~
;
A~ril , 19 72 „ and 1 reside at ~18 1~'rd-Mar Plaee
(Sueet and Number) '
Ft. Pier~e , 3t.Zucie County, Florida,
ccitr)
i
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any pertinent tacts. such u sale of property or businrss, or reli~quishmmt of employmeot at tormer
domic~7e, removal of family to new domicile, purchsse oi home. elc.)
E~tablishing residence and entering child in school
aT~iuciF couNTY ~i~.
ROCER POITRAS `
CLERK C~ttCWT COUItT t
RFCORD YER~FlEO~..~,~,~
f ~
Miur !Q 4 s2 PM 7Z _ t
i
~ ~ ~
~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
Ft.Pierce St.I,ucie
, County,
Florida, permanently. «''y~
- ~ ~ ~J j.~:f+ • .
- 1
`f\ .
" . ~ : :
~ ~ ~ (Namt
_ Elizabeth Ha~ulias (~:rs Anaataei
- . . 1 r' : c ' Udaresa)
` e
:
~ S~~L;fq'~~d subscribed before me this __10~? day of
~a A.D.19 72
Notuy Public ot klorids ~t Lar6e
My Commission expire - ~
(To be e:ecuted in duplicate and oriRinal CJed with Clerk Circuit Court, and duplic~te with Tau Assessor)
~I
~ ~OOK~~ PACE ~~O~
I AGO Eurm 71 ~Z
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